Principles and Practice of Pharmaceutical Medicine

medicine (in no particular order): ethics, chemis-
try, pharmacology, computational modeling, phar-
maceutics, projectplanning,toxicology, regulatory
affairs, logistics, quality control engineering,
biostatistics, pharmacogenomics, clinical trials,
politics, economics, public relations, teaching,
pharmacovigilance, marketing, finance, technical
writing, data automation, actuarial analysis, infor-
mation science, publishing, public health, interna-
tional aid and development, intellectual property
and other types of laws. However, this is not an
exhaustive list. Surely, there can be no other indus-
try with as many diverse professionals as this one
where all havethewelfare of other human beings as
their ultimate concern? And for those with a life-
long thirst to learn on a cross-disciplinary basis,
this breadth of intellectual interaction is a magnet.
Conversance with, if not advanced capability in,
these specialties should therefore be an early goal
of any career in pharmaceutical medicine. Those
who remain in the industry thereafter usually value
their initial generalist experience. But eventually,
for most practitioners, the opportunity will exist
either to remain as a generalist in pharmaceutical
medicine or to sub-specialize within one or more
areas in the list shown above.
But, perhaps the greatest difference between this
specialty and all other specialties is the value
placed on versatility, adaptability, communication
skills and teamwork. Physicians and pharmacists
must learn that in pharmaceutical medicine, they
are unlikely to be as predominant as decision
makers as they were in clinical practice. Those
who can become an expert in some subject and
berespected for itbypeople bothinsideand outside
the company, even though they may never have
heard of that particular disease or drug before three
months ago, will do well if they can match such
knowledge with superior inter-personal skills.
Knowing when to lead, when to follow and when
to get out of the way, rather than presuming a
leadership role in all situations, will always be
valued in this specialty.
Finally, what about those who do not stay in the
speciality? Any clinician who spends just two or
three years in pharmaceutical medicine but then
returns to his or her clinical calling, will have
benefited, if only having learned something about

oneself and what one does not like to do at work!

But, nonetheless, there will usually be an opportu-

nity to gain some management experience and

skills and to look at the therapeutic enterprise

from a different angle: Appropriate scepticism

with regard to the wanted and unwanted effects

of drugs, and the ways they may be properly and

improperly promoted, is best learned inside the

industry and applied outside it. ‘Clinical re-entry’

after twoor threeyearsof pharmaceutical medicine

will not be associated with being out of date in

terms of knowledge and skills base, although re-

entry after 10 years almost certainly will. Those

attempting the latter should anticipate the need for

re-training.

1.1 Organizations and

educational systems

Most countries in the developed world have one or

more national societies or academies devoted to the

specialty of pharmaceutical medicine. All hold

education and training as central to their mission,

whereas some societies will engage in regulatory

or political debates when particular issues arise.

The first formal post-graduate qualification to

acquire in pharmaceutical medicine is a Diploma

in Pharmaceutical Medicine (DipPharmMed). It

requires two years of part-time study and tests the

knowledge basis for the specialty. This diploma has

been examined by the Royal Colleges of Physi-

cians (RCP) in the United Kingdom for more than

30 years, and its possession qualifies the holder for

membership in the Faculty of Pharmaceutical

Medicine (MFPM). The Belgian Academy has

more recently introduced a diploma which is

recognized reciprocally with that in the United

Kingdom, and accordingly, there is periodic

exchange of examiners. Switzerland is likely to

be the next, and progress toward an analogous

goal (‘Board certification’) is being made in

North America. At least two years’ experience in

clinical medicine and prescribing is a matriculating

qualification for these diplomas; in countries where

the roles of pharmacists, physician’s assistants and

nurses include prescribing responsibility, these

4 CH1 THE PRACTICE AND PRACTITIONERS OF PHARMACEUTICAL MEDICINE